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HomeMy WebLinkAboutMiscellaneous - 57 ESSEX STREET 4/30/2018 (2) 57 ESSEX STREET 2101103.0-00 55'55"0000.0 Date 7 .. ......... t "OR71y 3?;�,�``°;•.�"COAL TOWN OF NORTH ANDOVER Awim p PERMIT FOR WIRING SSACl1US� � M This certifies that ...x.G: nn.: .1........, G:P� .. �.r.�...................... has permission to perform So.Aj A . f..u;5,.... 'a. 'v. . ........ wiring in the building of.................�.�........�............................................... ....................................... North Andover,Mass. a Fee.,,-70......... Lic.No.C� .1 'J....... ... .... ........ ....... ..... . . .... ELECTRICAL INSPECTOR Check # J 'ti Official Use Only THE COMMONWEALTH OFMASSACHUSETTS Permit No. Deportment of Public Safety BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 Occupancy&Fee Checked APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code 527 CMR 12:00 (Please Print in ink or type all information) DateX.-3—P,TW4 _ To the Inspector of Wires: Town of North Andover The undersigned applies for a permit to perform the electrical work described /y below. Location(Street&NumberJ_ 7 ����X 1 Al. A,,T�mVI?-,r M-A y s Owner or Tenant Ike ei ! Ak,'—' LgeAY Owner's Address r�Ate; A r `A13CY1 Is this permit in conjunction with a building permit Yes (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service_-i'9(? Amps _t�y Voits Overhead- Undgmd • No.of Meters 1 New Service Amps Voits Overhead Undgmd • No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work 64011'R'bb;,�, p j IDLA/A, P:&-I Aye% 1 Total No.of Lighting Outlets No.of Hot fuse No.of Transformers KVA Above In No.of Lighting Fixtures Swimming Pool qmd gmd Generators KVA No.of Emergency Lighting No.of Receptacles Outlets No.of Oil Burners Battery Units No.of Switch Outlets No of Gas Burners FIRE ALARMS No.of Zone Total No.of Detection and No.of Ranges No of Air Cond Tons Initiating Devices Heat Total Total No.of Di osal No. Pumps Tons KW No.of Sounding Devices _ No./of Self Contained No.of Dishwashers Space/Area Heating KW Detection/Sounding Devices • Municipal • Other No.of Dryers Heating Devices KW Local Connection No.of No.of Low Voltage No.of Water Heaters KW Signs Bailases Wiring No.Hydro Massage Tuds No.of Motors Total HP ✓J OTHER: �r -Z-!L/ �C��c�✓ ;�ar�trlS i�l„P/9c'/� ��f/7/� j S//srl,9 t'7� X"tom INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YES= NO = have submitted valid proof of same to the Office YES= NO = If you have checked YES please indicate the type of coverage by checking the appropriate box. INSURANCE = BOND = OTHER = (Please Specify) (Expiration Date) Estimated Value of Electrical Work$ Work to Start , _ Inspection Date Resquested_J-dr 'Z O Rough___ Final .,Signed _ FIRM NAME under the Pen It perjuryLA-el lm7 /"lI!ZZ �� Oe0& LIC.NO. Licensee ,L` Signature _ __LIC.NO. Bus.Tel No. q f - Address Alt Tel.No. 7P- 711 tfzGL ! i OWNER'S INSU NCE WAIVER: I am aware that the Licenses does not have the insurance coverage or its substantial equivalent as rrauired by Massachusetts General Laws.And that my signature on this permit application waives this requirement. Owner Agent (Please Check one) _Telephone No._ ---PERMIT FEE b__ _ (Signature of Owner or Agent) J roPTVV py_ 40 Title: One-Line Plot Map for PV system Layer Drawn By: Daniel P. Leary, NexGen June 27, 2006 Photovoltaic Array •� (2.5 kW DC) inverter and DC/AG Disconnects t, Building Service Panel t N?,-. .cr.•ft•r• �a Nc -!dJ r-%v � 7c7 ice', 1" EMT conduit with #10 PV Array (24, 102 Watt AWG, THWN conductors and modules in 2 series strings of a #10 AWG, THWN 12 modules, notes 1&2) equipment groundi g conductor. 4°x8"x4-' NEMA 4 Approximate distance Junction from array junction box to Box switch is 75 feet Note 3 power Source: Sub=Panel Disconnect with 15-arnp Note :: two P616 circuit breaker; for Interactive IriVerter is 60 point of feet from connection S0lactra Renewables, LLC . I Integrated:INbrter meter, and disconnects panel (. .. . . 5, 6,,7, 8; 5,: , & 10). 1. PV Array contains 2 parallel strings of 12,102-watt modules in series(24 modules total) 2. PV Array wiring to combiner is#10 AWG USE-2 with factory-installed MC connectors to modules. 3. PV Array Junction Box provides transition from array wiring to conduit wiring. I 4. PV Power Source Disconnect(unfused)rated at 30 amps,600Vdc,NEMA 3R Rainproof. NexGen Energy Solutions, LLC ,7 5. Ground Fault Protection provided in DC/AC Interver. 6. DC/AC Inverter is PV12500 model rated at 2.5 kW AC output. Title: Schematic PV System Drawing 7. Inverter is Listed to ULA 741 "Utility Interactive" 8. PV Output meter is Form 2S kWh meter with cyclometer register. Drawn by Daniel P. Leary 9. Inverter Output Disconnect rated at 30-amps,240 Vac,NEMA 3R 10. Utility switch is visible open,lockable in open position,240-Vac,30-amp switch. June 27, 2006 11. Equipment grounding conductors on AC-and DC-side sized according to NEC 250.122 12. Negative Pole of PV array referenced to ground at the inverter Scale: NTS 13. All grounds connected to main service ground in Main Service panel. TECHNICAL SPECI JfATtfJ tS PV/18001PV1256 P1 PV12 Fr �: InputContinuous power 1980 W 2750 W ' ELI B , I `DU T I I LIT ! Recommended Max.PV array power,STC rating 2200 Wp 3100 Wp MPPT voltage range 125V DC-350V DC 125V DC-350V DC RLIstiBILITY Maximum voltage(OCV-cold) 400V DC 400V DC I rA t800"25DD provides Indus"leading rNi �,•pjoductioh end PCB assembly inside the Maximum DC current 17 ADC 15 ADC mfr ^ter sfiu na itQindusmat:tmaktyeGRi°gjSrous(y desi ed afs edu�bai stz idiwr, 5 250p pfiv io 1 i �' T Able, , x: r • r _ Continuous power 1800 W 2500 W - _ Nominal voltage 240/208V AC 240/208V AC Voltage range 240/208V AC-12%/+10% 240208V AC•12%/+10% Nominal current 7.5A/8.7A 10AA/12A Frequency 60 Hz;+/-1% 60 Hz;+/-I% EASY TO INSTALL SAFETY Power factor Unity Unity The PVI 1800/PVI 2500 can be installed easily and quickly, The PVI 1800/PVI 2500 has been tested to the UL1741 Distortion factor(THD) <4% <4% both indoors and outdoors.With a weight of 35 Ib.(16 kg) standard and meets all the requirements.An important Operational overall efficiency >93% >93% (compared to an average 70 lb..(32 kg)for a typical inverter) selling point of this inverter is the galvanic isolation,which General Information the PVI 1800/PVI 2500 is very easy to handle.The inverters increases both reliability and safety. DC and AC connections pre-wired pre-wired also include'pre-wired'AC and DC cables for quick wiring at the jobsite without opening the inverter) HIGH THERMAL PERFORMANCE Housing material Aluminium Aluminium Convection cooling Yes Yes/Fan All aluminium construction and high efficiency design provi- Weight 34.2 Lbs/15.5 kg 36,4 Lbs/16.5 kg EASY TO OPERATE.PLUG AND PLAY des full rated power in ambient temperatures up to 130"F Ambient temperature -13°F to+140°F -13°F to+140°F With the PVI 1800/PVI 2500,Solectria once again confirms (54°C).No derating will occurl Relative humidity 95% 95% its innovative reputation.With LCD display and auto detect Enclosure NEMA 4/IP 65 NEMA 4/IP 65 RS 232-485 as standard equipment,there is true'Plug and play'capability This gives the PVI 1800/PVI 2500 a PC Dimensions interface with excellent monitoring and data acquisition Length 18.5 inches(470 mm) 23.6 inches(600 mm) capability. Width 13.1 inches(333 mm) 13.1 inches(333 mm) Height 5.63 inches(143 mm) 5.63 inches(143 mm) `. I� Communication 5 Indicators LCD display&LEDs for status indication and error messages External communication RS 232 or 485(standard equipment) (automatic recognition of RS 232 or 485) Fy t7 p Data logger PVIDAQ PC/Modem/Cell based logging Standards •I Et sf tx m Designed to meet UL listed to UL1741 UL listed to ULt 741 0 IEEE1547AEEE929 IEEE1547AEEE929 FCC part 15 A&B FCC part 15 A&B ANSI C62.41 Cl&C3 ANSI C62.41 C1&C3 _ -- Warranty Standard 5 years Standard 5 years :rr rr 05MECTRIA RENEWABLES rAWFIFA -. -. • The Solectria Renewables Integrated Panel Assemblies are i3O options that can be added to the PVI 1800 or PVI 2500 j inverters. They can be used with inverters set to a grid i voltage of 240VAC or 208VAC. This panel makes . installing a PV system even faster and easier. The complete panel with inverter weighs only 65 lb(29.5 kg)and ships via UPS. The standard version includes visible-blade AC and 1 DC disconnects, an optional revenue-grade, factory sealed, � Cv reconditioned easy-read kWh meter and meter socket all mounted on an aluminum panel using only stainless steel hardware. The design compliments the sleek, low profile construction of the inverters providing a clean, compact installation whether indoors or outdoors. 'Applications 'Specifications 1-3 kW single panel residential or commercial installations Output (single•inverterpanels) • Multiple 1-3 kW residential or commercial installations Maximum Cont.Power 250OW with PVI 2500 that are separately metered such as town houses,condos Maximum Cont.Power 180OW with PVI 1800 or apartments. Voltage(L-9,-12%,+10% 240/208 VAC,single-phase • Multiple paralleled 2-3 kW systems where panel is used Max.Cont.Current,PVI 2500 10.4/12 A(240/208AC) without kWh meter and the panels are combined to go Max.Cont.Current,PVI 1800 7.5/8.7 A(240/208AC) through a kWh meter if needed. Two&three-inverter Frequency,±1% 60 Hz,pure sine wave panels available for 4-9 kW Systems(3.6-7.5kW AC) Inverter peak Efficiency 94%(50°/.-100°/.1 • Special versions of the panel available by request with Input (single-inverter panels) various parts omitted,added or substituted(for example Array Configuration:Monopole,negative grounded meter,meter socket or either disconnect). Max Voc 2 1400 VDC Max.DC Current(1800/2500) 11/15 A(inverter controlled) MPT Voltage Range 1175-350 VDC Protection • Fully integrated design includes AC&DC disconnects, AC Grid-connection Over/Under Voltage optional DC combiner-fuses(3),kWh meter. (Standards Compliance: See Over Current • Mounting holes every inch at top and bottom for entire "Safety Features") Over/Under Freq. 33"width so you can always catch at least two studs. AC Disconnect(Integral) NEMA 3R,w/fuses • Simple set-up and connections (connect DC from PV DC Combiner-Fuse Enclosure 10A/15A fuses available,3-pole, strings and 3-phase AC connections). (Optional NEMA 31? TVSS • REC-trading simple with revenue-grade kWh meter. DC Disconnect(Integral) JBreak load rated,NEMA 3R Environmental • Panel is robust and corrosion-resistant made with all Ambient Temperature -20 to 55 deg C(full tat ing) aluminum construction with stainless steel hardware. Storage Temperature -40 to 70 deg C Cooling 1800 Passive,2500 Forced Air ConnectivityDisconnect&Meter Enclosures NEMA 3R Enclosure-electronics NEMA 4,IP-65 • RS232/RS485 for diagnostics and data capture. General • Optional (Free) PC software for data viewing and Weight 65 lb (29.5 kg) logging. Shipping weight r 731b 33.2 k • Optional Fat Spaniel web-based,plug&play"inverter- Dimensions: inches[mm] 33"[838]x 26.88"[683]x 8"[203] direct"data logging. See 2"d page for 2&3-inverter panel Shipping box size:inches 1-1 38"[965]x 32"[813]x 11"[279] Warranty 5 years • • 'Fully Integrated Panel:Includes AC&DC disconnects,meter and meter socket and optional combiner-fuses in DC disconnect. See back page for • Digital meter with pulse for automated REC reporting. = weights of double and tripleinverter panels. Max Open circuit voltage(Voc)of PV array(per NEC 690-7) • Optional CSG Soltrex for automated REC reporting. p ;Complies with grid connection and safety standards("Safety Features") cc °Integrated into DC disconnect if selected • Optional Fat Spaniel Inverter Direct"monitoring unit. 5 • Fused DC disconnect for 3-string PV configurations. depth is 6s'(165mm)without the kWh meter. • Double and Triple-Inverter Panel versions available. See String sizing at www.SOlreri.COm Solectria Renewables,360 Merrimack Street,Building 9,Lawrence,MA 01843,USA Tel 978.683.9700/Fax 978.683.9702/invertersnasolren.com/www.solren.com Revised March,2006. All specifications subject to change. 00.16(04)GROUNDING HOLE 25.69(653) 1.25(31.75) 20.03(509) m 3.26(83) 6.27(159) v c JUNCTION BOX EC 102/ 110/ 1 IS • car arc■n■xa zrw�^an-aa c.ar•_.:-.ns••...,..... 00.26(06.6)X 10, Designed for N FOR 1/4"(6mm)BOLT MODULE DATA AND maximum performance: SAFETY LABEL CABLES safe, reliable, versatile and easy to install. Nn 1 10 a+ ^+ CONNECTORS STANDARD EVERGREEN [CLEAR ANODIZED ALUMINUM FRAME 00.16(04)X4 GROUNDING HOLE 0.16( 4) GROUNDING HOLE 20.03(509) SCREWS X 8PROTRUDE.08(2mm) -� 1.39(35) 24.40(620) Dimensions:Inches(mm) Weight:Ib(kg) 28(12.7) ELECTRICAL SPECIFICATIONS* I-V CHARACTERISTICS* TEMPERATURE EFFECTS EC-102-GL EC-110-GL EC-115-GL 8.0 EC-115 PP= -0.49%/°C Pp 102 110 115 7.0 Vp= -0.53%/°C EE� 6.0 EC 110 Vp 16.7 17.0 17.1 I +0.049%/°C Q�5.0 EC 102 P - Ip 6.11 6.47 6.73 4.0 NOCT=44°C Voc 21.3 21.3 21.3 U3.0 Voc=-0.41%/°C ISc 7.32 7.48 7.62 2.0 Isc =+0.088%/°C Cells 72 72 72 1.0 Max. Series Fuse� 15A�� - 0.0 0 5 10 15 20 25 UL System Voltage Rating 600V ........................................................---..._-........................................---....................................................... Voltage(V) TUV System Voltage Rating 800V *At STC(Standard Test Conditions):1000 W/m',25°C cell temperature, AM 1.5 spectrum.Power specifications are-2%at Evergreen Solar s tester, other specifications are+/-10%.Specifications subject to change without notice.25 year limited power warranty.Complete warranty available on request. SAFETY AND QUALITY TESTS 138 Bartlett Street,Marlboro,MA 01752-3016 USA ■IEC 1215(IEC 503, ISPRA)Certified T.866.357.2221 or 508.357.2221 F:508.229.0747 www.evergreensolar.com ■ UL LISTED Class C Fire Rating Evergreen Solar,GmbH t ■TUV Safety Class II Certified Joachimstaler Strasse 15,10719 Berlin Germany EVERGREEN ■ Cc T:+49(30)8861 4520 F:+49(30)8839633 SO L A R 115v3.8GLu Primary Contractor/Vendor Contractor/Vendor Company: NexGen Energy Solutions,LLC Contractor License#:CS 093806(MA) Contractor/Vendor Contact:Dan Leary Phone#:(978)682-2479 Street Address:857 Turnpike Street,Suite 233 Email:dan.leary@nexgen-es.com City,State,&Zip Code:North Andover,MA 01845 Website(if applicable): www.nexgen-es.com Electrical Contractor Contractor/Vendor Company: Manzi Electrical Corporation Contractor License#:9472A Contractor/Vendor Contact:Paul Manzi Phone#:(978)356-8818 Street Address:43 Hilltop Road Email:paul@manzi.com City,State,&Zip Code:Ipswich,MA 01838 Website(if applicable):www.manzielectric.com • NE*QCT I Integrated Panel Assemblies RENEABLES Dimensions Mounting holes every 1.0"top Single,Double and and bottom(26.25"center-to- AC Triple-Inverter center from top and bottom row) disconnect Panel Dimensions: All Panels are 26.88" high,all outdoor rated except where noted. DC , 3 a Single-Inverter Panel disconnect (all):33"wide i Double-inverter panel with DC disconnect ' 2C,88" but no meter/socket or ., .. u AC disconnect:37" wide (89 lb) _ m Double-inverter panel with DC disconnect, ` •+ " „y .. AC breaker panel (indoor)and optional . ` r meter/socket 48"wide IT (104 lb) 33.00" Triple-inverter panel with DC disconnect t Optional but no meter/socket or KWh AC disconnect:51" i Meter and wide (127 lb) socket System Block Diagram ,11800 AND V12500 PV SYSTEM BLOCK DIAGRAM F41 fv See string sizing at www.solren.com yNIV 0 0 0 Eli � 000 E # aw12t0 ) urs R ' 9 e y/ CIG tl+Stort*d- � r---- W1t�Y�@h7'ql' a Ac 1j1ECt1moa how .}s g7v ,« _ rr � 1< 4Uldltlg PR TION AC fttrbwpn htl""f�Ct oL+Mmy two t Tr rats { n tiea!} We,.Grows fault Detsaawin%mv no 4roon in 64ie.dsegrctst: 7 IML004 t.asras r:O B Solectria Renewables,360 Merrimack Street,Building 9,Lawrence,MA 01843,USA o'" e G Tel 978.683.9700/Fax 978.683.9702/invefters(@,solren.com/www.soiren.com Revised March,2006. All specifications subject to change. IN �f CEDAR LINETIVI PHOTOVOLTAIC MODULES V • EVERGREEN SOLARe i Bright ideas . Brilliant technology. Q Producing our own wafers,cells and modules assures that the highest ' quality components go into every one of our panels.And since they • are made with String RibbonTM technology,our panels take advantage t of one of the newest,fastest-growing,most environmentally friendly manufacturing processes available in the world. Evergreen Solar is a fully integrated, independent company.Solar is V • is g F = our only business.Our commitment to the environment is matched only by our commitment to our customers. If, like us,you want the best in solar, make the pure choice...Evergreen Solar panels. Advanced technology with promise for the future Easier,faster, more accurate wiring ■ String RibbonTM polycrystalline solar cells outperform thin • Sealed junction box never needs maintenance. films and achieve comparable performance to bulk crystalline ■ Easy,accurate,reliable electrical connections. technologies while using half as much silicon. Comes with factory-installed wires,connectors,and ■ The proprietary cell fabrication process is among the most bypass diode(s). environmentally friendly in the business. The power of PV Predictable, reliable, long-term performance ■ photovoltaics(PV)provide clean,quiet,reliable electricity in Each module is individually tested to ensure field performance from sunlight. meets or exceeds specifications. a No moving parts to wear out. ■ Solar cells are matched to reduce internal losses and the ■ No emissions—power that's good for the environment. possibility of hot spots. ■ Rugged,durable anodized aluminum frame makes for strong, ■ The sun a limitless,readily-available power source. stable mechanical mounting. is Industry standard EVA(Ethyl Vinyl Acetate)and TedlarTM construction protects solar cells from mechanical and environmental stress. • SOLECTRIA Integrated Panel Assemblies, RENEWABLES Dimensions Mounting holes every 1.0"top Single,Double and and bottom(26.25"center-to- AC Triple-Inverter center from top and bottom row) disconnect Panel Dimensions: All Panels are 26.88" high,all outdoor rated except where noted. DC Single-Inverter Panel disconnect # , (all):33"wide �4 Double-inverter panel = with DC disconnect 26,88" but no meter/socket'or AC disconnect:37" „y wide (89 lb) Double-inverter panel W with DC disconnect, AC breaker panel J - ~ � (indoor)and optional ` meter/socket 48"wide ,l (104 lb) 33.00" Triple-inverter panel with DC disconnect a Optional but no meter/socket or an KWh AC disconnect:51" _ Meter and wide (127 lb) socket System Block Diagram PVIISOO AND PV12500 PV SY'ST'EM BLOCK DIAGRAM See string sizing at www.solren.com +s xs o Ij FanIPv12100) UTXI V A.` DC QYIf{nneGt ...........w«...........» ti !> i !uBed - >rt�,irt►y AC Dissunnrct WH Pd FRf?Gf7 !1 I _ Jugdnq AGJ+3SMiutiOn ­1 p1lod f rx trr f UHC 1 N e.(Zrouca Faun Ci4ta pntF amr not c;vNn at M*disgtari 6UiLDI.YG LGADS Solectria Renewables,360 Merrimack Street,Building 9,Lawrence,MA 01843,USA Tel 978.683.9700/Fax 978.683.9702/inverters nsolren.coin/www.solren.com Revised March,2006. All specifications subject to change. NoDate.... + TOWN OF NORTH ANDOVER 0 PERMIT FOR WIRING �SSACON ...�j��.tJ This certifies that ....... has permission to perform ..... P—k.4; ✓ ................................................... wiring in the building of..... ...... ......................................... at...... ....... .7.....`......... North Andover,-/ S. Fee-6.-J.0... Lic.No.j.—.�-/ .. .... ............. 1001, ELECTRIC;i INSPECTOR Alza//99 11:26 15.00 PAID WHITE: Applicant CANARY: Building Dept. PINK:Treasurer T1EC0M1101 WE4LTHOFM SSACHIIS= Office Use only DEPARTAffYST0FPVBLICS4FM Permit No. W// BOARD OFF/REPREVEM0NRWHA7I0NS527CW 1200 ' Occupancy&Fees Checked APPUCATIONFOR PERMITTO PERFORMELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE,527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date,M / Town of North Andover To the In pector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location(Street&Number) ,r.> �'� y. <r- Owner or Tenant Owner's Address ''-> e:e, z:- Is this permit in conjunction with a building permit: Yes© No (Check Appropriate Box) I Purpose of Building / Utility Autho nation No. D� Existing Service =,d 0_ Amps/ %y p Volts Overhead Underground E-1 No.of Meters New Service ' Amps / Volts Overhead Underground No.of Meters Number of Feeders and Ampacity 4 Location and Nature of Proposed Electrical Work r.. o -V o, All.. 1777777/ No.of Lighting Outlets No.of Hot Tubs No.of Transformers Total 1 KVA No.of Lighting Fixtures Swimming Pool Above Below Generators KVA ground round No.of Receptacle Outlets No.of 0il Burners No.of Emergency Lighting Battery Units No.of Switch Outlets No.of Gas Burners No.of Ranges No.of Air Cond. Total FIRE ALARMS No.of Zones Tons No.of Disposals No.of Heat Total Total No.of Detection and Pumps Tons KW Initiating Devices No.of Dishwashers Space Area Heating KW No.of Sounding Devices No.of Self Contained Detection/Sounding Devices No.of Dryers Heating Devices KW Local Municipal Other Connections No.of Water Heaters KW No.of No.of 4 Signs Bailasis Uro.Hydro Massage Tubs No.of Motors Total HP 1 OTI-IE • Plasuattbthe G�LAWS IhawaomattLmbtlityhELra=Pdcyurh&gCanpke CowWcrics eWwalat YES © NO Iha\esut ngedvatidptoofofsanebdie0foe YES L_.1 NO ffyculmedvdWYES,pleasewdc*thetypeofWMaWbyc=kngthe WSURANCE BOND Off-IER M fteseSpeafy') ExpcabonDae Estms*d VahledfEkftal Wcdc$ WctktoSlatt/O"p-?, InspedirnDallec� eRd Ra* FM . signed trrlaSte �ofptajtay. �� / FIRMNAME /C�L'��z� // �/�-iI� Z"'o U=Wllia Z� oP; A-ddasS../oJ.. 1VA1 1�. ��.�.?2e- AJ Alt.TCL Na OWNER'SWSLR WAIVER;Ianawatethattheliomdxs tl ig$Ieis=aneao ontssi*mrtele4r4mtasle#WbYMam±&E ►s71Lr-d andel atmysi�lattpernt*ap ftpp�onwa'rAsd ismp'm nat. (Please check one) Owner � Agent M Telephone No. PERMIT FEE v